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Susan Ivy, Nurse (RN)

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I take 4 medications for bipolar celexa 40mg in the morning;

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I take 4 medications for bipolar: celexa 40mg in the morning; and risperdal 4mg, tegretol XR 800 mg, and valium 20mg at night. (I also take an iron pill in the morning.)

This morning I forgot my morning meds. I had a great day, much contrary to my usual depression; actually got up and exercised; scheduled some work on a job project which I hope will get me off disability; took a shower even though I was not leaving the house, a very rare thing for me with my depression; and laughed and joked with my roommate all afternoon and evening. I even considered taking off my MedAlert necklace which reads "DNR - no lifesaving or life-prolonging measures whatsoever." I am consistently suicidal, as you can tell, and the necklace is one possible way to that for me; for me to consider not wearing it any more seemed a huge step and I felt great.

Now, I understand all this if I had forgotten my mood stabilizers and was manic. But I forgot my one antidepressant. 1) Why would I react this way? and 2) can I draw some information from this reaction that might help my psychiatrist better medicate me? I naturally want to reproduce/continue this reaction as much as possible.

UPDATE: Second day. I took my celexa last night, with all my other night meds, and slept well, several hours less than normal, which is to say about 10 hours. This a.m. I skipped my celexa again, to see if I could reproduce the symptoms. It has worked. I have not felt sleepy all day, I managed well alone although my roommate was gone most of the day, usually a very hard thing for me. AND I took an important step toward starting in a local volunteer effort, the Coast Guard Auxiliary (I'm a veteran). I had been so hopeless about this because my joints are bad (age) and had given up, and now have sat up and signed up for radio training, a dream of mine for many years. I will keep on taking the celexa at night for now, but can't get in touch with my psychiatrist for a week, and would like to hear from you about if this effect makes sense. I like to have explanations for my mental health behavior, it makes me feel safer. Please help.

You are doing the right thing by being very careful about your medications and checking in with someone, a professional about them.

It is interesting that when you withheld (I understand by accident the first time) the morning dose of your Celexa, which is an antidepressant that your mood improved. As you know, typically one would expect this to happen when a more sedating type of drug was decreased.

But, especially with psychiatric medications, individual chemistries vary, and what is sedating for one individual may be stimulating for another and vice versa.

At this point, I think it would be too soon to say that the effects are definely due to with holding the Celexa, because it is possible that it is a coincidence and that your mood has improved for another reason.

But at the same time, I very much think it is important to always listen to the patient. You know yourself the best.

I can understand you wanting to continue holding the morning dose - it sounds like you for the first time in quite some time have a hopeful out look.

One thing that I would recommend is that you journal daily while this is going on (withholding the am dose of Celexa), at least until your psychiatrist gets back. Having your moods and thoughts daily on paper will allow for a good way to document or follow your moods. Keep the journal and take it with you when your psychiatrist comes back. This will help to show whether your mood remained stable with this doseage change.

You are also welcome to write back to me here and I will be happy to follow you if you have any questions. I realize this might not be practical, but if you are more motivated to write when you know you will be read, rather than in a journal, this is an option for you.

Also, pay attention to your sleep, recording how many hours of sleep you are getting each night, to make sure that it does not show any shortening.

Journaling is a very good technique to use for many reasons, but can be a great tool when one is monitoring their moods.. There may be some mood changes that are not medication related, and documenting some of the things going on in your life and your mood at that time can sometimes help to lead you to activities that are beneficial for you (as well as making it more evident when things seem to put you in a poor mood)

I reread your post - and it seems though you have not actually stopped your celexa, but just switched it to night. That is a very reasonable thing to do.

I hope this is of some help. Feel free to write back with any additional questions or clarification if needed.

(I also just noticed that this is a very old post - 1 day and 10 hours old!) I am not sure why it has taken so long for it to be answered - I think it must have been transfered from mental health to health, as I did not see it last evening listed.

I will tell you that...the things you have to go through to be an Expert are quite rigorous.

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